This speciality is predominantly concerned with the psychiatry of patients in the general hospital setting. It involves the psychiatric management of patients who present with physical symptoms, and the treatment of psychiatric illness in physically ill patients. In addition, it also includes the management of patients who deliberately self-harm.

In 1886, the Medico-Psychological Association established its own examinations leading to a certificate of psychological medicine. Although discussions concerning the setting up of this certificate clearly indicated that it was regarded as a qualification for men, by 1888 women medical practitioners were sitting the examination and appear, without comment, in the lists of successful candidates. However, the question of the admission of lady members to the Association proved to be a much more controversial matter.

Hamilton is New Zealand's fourth largest city. Situated on the banks of the Waikato river in the central North Island, it was my home during a year's experience as a psychiatric registrar in the Waikato Hospital. This paper describes aspects of a medical and psychiatric practice, including training in New Zealand, and offers general advice to trainees planning or considering overseas placements.

In Japan the Mentally Disordered Persons Supervision and Protection Law (1901) and the Mental Hospital Law (1919) used to be the main laws for mentally disordered people. Subsequently, the Mental Hygiene Law came into force in 1950 but was criticised as it had restrained admitted patients and the provisions for procedures for the release of patients were inadequate. The purpose of the old law was to give medical treatment and custody to mentally disordered persons and to maintain and improve the mental health of the nation. In the revised law, enacted in July 1988, acceleration of social rehabilitation of mentally disordered persons and promotion of their well-being were added.

Community psychiatry is at present an ill defined specialty. The emphasis is on psychiatry practised in the community, often in the context of a community mental health centre (CMHC), although in-patient facilities are still an important component of most services.

This article deals with the organisation and evaluation of a pilot series of seminars at the Institute of Psychiatry on the relevance of social anthropology to psychiatry. Despite increasing interest in the relationship of culture to psychiatry, trainees have few opportunities to learn about anthropological issues in psychiatric theory, practice and research. The present authors, all with higher degrees in social anthropology, believe that this is one of the first seminar series of its kind in the country specifically for mental health trainees. Some further possibilities for developing and applying this teaching are also considered.

Since the demise of the Ceaucescu regime in Romania, the media has been presenting a grim catalogue of life in Ceaucescu Romania. Even as these stark images were unfolding, Bristol MENCAP, independent of the national organisation, was putting together a package of humanitarian aid directed, predominantly in the first instance, to orphanages in and around the city of Cluj-Napoca in the province of Transylvania, Romania. Our department has close links with the National Executive of MENCAP and we were approached by Bristol MENCAP to undertake a fact-finding mission on the current state of professional services for the mentally handicapped in general, and that of the Department of Psychology at Cluj-Napoca University in particular.

Guardianship can offer a measure of control and support in the community to individuals suffering from any type of mental disorder, be it mental illness or mental handicap, yet there were only 14 new guardianship cases in Scotland in 1989, compared with 3,604 episodes of detention under the Mental Health (Scotland) Act 1984 (MWC Annual Report 1989), and out of an estimated total of mentally disordered people in Scotland of more than half a million (Titterton, personal communication).

The importance of interview skills in psychiatry cannot be underestimated, and the acquisition of adequate interview skills must be one of the foremost aims of training. The College requirement that MRCPsych candidates must interview the patient in front of the examiners (in both parts I and II) rightly stresses the fundamental importance of interview skills in clinical practice. Maguire (1982) has questioned the adequacy of standard methods of training psychiatrists (usually reporting and discussing interview findings with a senior colleague) in interview skills. In a study of medical students, he has shown that audio/videotaped observation of interviews with feedback is superior to traditional methods (Maguire et al, 1978). Gask et al (1988) demonstrated that use of group video feedback training was effective in improving psychiatric skills in a group of general practitioners. Rutter & Cox (1981) published a series of studies examining the effects of interview style on the quality of factual information obtained and the emotional response elicited. Such work has generated interest in interview skills training and specialised courses are now run in some centres.

Recently there has been an increasing awareness of the need for medical audit. Medical audit in the health service is not a new thing across the Atlantic. Many centres accept it as a normal part of health management. The findings of audit are made known to the individuals who have been audited with the aim that this would produce future improvement. Hence it is an effective way of increasing efficiency and highlighting inefficient and costly procedures. There is debate as to who should be doing the auditing. General practitioners have been suggested as being in the ideal position to be able to audit specialist services such as psychiatric services (Ferguson, 1990). GPs can be approached by questionnaire to gain their views as to the level of satisfaction on things such as communication, availability and usefulness of referral to a local specialist service (Markantonakis & Mathai, 1990).

The anxiety of staff working alone with overdose and deliberate self harm patients can be high, and demands more recognition. In assessing and treating such patients, staff often feel that they are being required to take responsibility for someone's future in the face of an enactment of extreme despair. This article looks at one way to deal with such anxiety.

It is in the nature of eagles to fly. It is in the nature of human conditioning to develop attachments and aversions. The story is told of the court monkey who finds a luscious fruit inside a narrow-necked bowl. When the fruit is grasped however the monkey's full fist does not allow him to withdraw his hand, yet to the amusement of onlookers he will not relinquish the object of his desire. How foolish!

First of all, some definitions. In general, psychotherapy is what happens when a doctor speaks to a patient. More specifically, psychotherapy is talk as therapy: it involves the physician assuming a role of expertise in talking.

In May 1988, the greater part of an issue of Archives of General Psychiatry was given over to reports of the results of a clinical trial of alprazolam for panic disorder. More recently, in March 1991, supplement no 365, of Acta Psychiatrica Scandinavica (APS) was devoted to a further trial of alprazolam for panic disorder. Few other psychotropic compounds have received such concentrated coverage. What, if anything, emerges from the studies reported?

One week before Christmas in the crypt at the Church of St Martin-in-the-Fields, Dr Malcolm Weller addressed a conference for CONCERN (Care of the Neglected: Combining Education, Rehabilitation and Nursing). The purpose of the conference was to highlight the plight of mentally ill, homeless people and to emphasise the strengths and shortcomings of the professional care available for them.

It is increasingly recognised that effectiveness and efficiency of health care delivery depends on sound clinical leadership. Few would now disagree that if doctors are to carry out their clinical and management roles effectively within the NHS they must have a full appreciation of the organisation within which they work and possess the necessary management and leadership skills. Good management is an integral part of good clinical practice.

Compliance with medication regimes is fundamental to successful treatment and hence familiarity with factors influencing the level of patient compliance is essential. In relation to the psychogeriatric population poor compliance is a major and worrying problem largely neglected by researchers.